Impact of Accessory Renal Arteries on Hypertension in Young Patients

Objective: To determine whether there is a correlation between hypertension, accessory renal arteries, and levels of renin and aldosterone. Design and method: From March 2023 to December 2023, 11 young patients (9 males and 2 females) between 22-41 years were hospitalized with suspected secondary arterial hypertension (AH). Prior to hospitalization, all underwent standard pre-analytical medication preparation with cessation of hormone affecting medications and transferred to alternative treatment. For all patients, a computer tomography was conducted following a renal angiography protocol for the presence of adrenal glands formations and the presence of accessory renal arteries. In parallel with the imaging study, laboratory analyses for renin/aldosterone, metanephrine, and normetanephrine were done. ECG, echocardiography and 24-hour monitoring of arterial blood pressure were performed. Results: In 10 (91%) of the examined patients, accessory renal arteries were identified - 2 (20%) on the right with two accessory renal arteries; 4 (40%) on the left, and the remaining 4 (40%) had bilateral accessory renal arteries. One patient exhibited an accessory artery in conjunction with Nutcracker Syndrome, and another patient with a combination of a hormonally inactive adenoma of the right adrenal gland. The average blood pressure during 24-hour monitoring was 165/96±12/8 mmHg. Echocardiography revealed initial left ventricular hypertrophy in 50% of the examined patients, with a trend towards reduced relaxation. Overall, 8 patients had abnormal renin/aldosterone abnormalities - 7 (64%) in the group with accessory renal arteries (ARA), and 1 (9%) in the group without ARA where primary hyperaldosteronism was diagnosed. In the ARA, 6 had elevated levels of both renin and aldosterone. In 1 case in ARA group, only renin was elevated. Metanephrine and normetanephrine levels were within normal limits in all cases. Conclusions: We find relatively high rate of the presence of ARA, which may be regarded as an etiological entity. Elevated levels of renin and aldosterone were detected in a significant subset of the patients. Hypertensive patients with ARA may develop early severe damage of target organs.